Provider Demographics
NPI:1942861802
Name:LASLEY, RALYN HELEN (RD)
Entity Type:Individual
Prefix:
First Name:RALYN
Middle Name:HELEN
Last Name:LASLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11660 W EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-8996
Mailing Address - Country:US
Mailing Address - Phone:208-323-0303
Mailing Address - Fax:208-375-3916
Practice Address - Street 1:11660 W EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-8996
Practice Address - Country:US
Practice Address - Phone:208-323-0303
Practice Address - Fax:208-375-3916
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-566133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered